Scientific article| Volume 34, ISSUE 3, P467-473, March 2009

Download started.


Dorsal Digital Septum of the Distal Interphalangeal Joint


      Clinical observation has led to the discovery of a distinct anatomic septum from the extensor tendon to the skin at the distal phalanx that appears to limit the proximal spread of infection from the dorsum of the distal phalanx. This study employed histology and high-resolution magnetic resonance imaging (MRI) to identify this anatomic structure at the level of the distal interphalangeal (DIP) joint.


      We used high-resolution (16.4-T) MRI to image and section 10 cadaveric fingers (9 female, 1 male) from both left and right hands. Once imaged, we made histologic sections using hematoxylin and eosin, or Van Gieson's stain, and examined them microscopically for concordant findings.


      In all 10 scans, the proposed septum was visualized using MRI with histologic confirmation. It was observed to extend from the skin creases overlying the dorsal aspect of the DIP joint to the extensor tendon. It is composed of collagen bundles arranged in a variable network that adhere extensor tendon to skin at the DIP joint.


      Clinical observations proposed the existence of a distinct septum between extensor tendon and skin at the level of the DIP joint. We confirmed this structure to be a collagen septum by MRI and histology. This previously undescribed structure is called the dorsal septum.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kanavel A.B.
        The classic.
        Clin Orthop Relate Res. 1974; 104: 3-8
        • Shrewsbury M.
        • Johnson R.K.
        The fascia of the distal phalanx.
        J Bone Joint Surg. 1975; 57A: 784-788
        • Cleland
        Cutaneous ligaments of the phalanges.
        J Anat Physiol. 1878; 12: 106-107
        • Milford L.W.
        The retaining ligaments of the digits of the hand.
        in: Tubiana R. Hand. WB Saunders, Philadelphia1981: 232-235
        • Pool Jr, R.
        • Stanisavljevic S.
        Paratendinous apparatus of the digital extensor mechanism: some clinical features.
        Henry Ford Hosp Med Bull. 1962; 10: 253-256
        • Pool Jr, R.
        • Stanisavljevic S.
        The paratendinous apparatus of the digits.
        J Bone Joint Surg. 1962; 44B: 910-912
        • Sommer N.Z.
        • Brown R.E.
        The perionychium.
        in: Green D.P. Pederson W.C. Hotchkiss R.N. Wolfe S.W. Green's operative hand surgery. 5th ed. Elsevier/Churchill Livingstone, Philadelphia2005
        • Slattery P.G.
        The dorsal plate of the proximal interphalangeal joint.
        J Hand Surg. 1990; 15B: 68-73